Colorectal Cancer Screening Dont Get Left Behind

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Colorectal Cancer Screening Dont Get Left
Behind
Linda Rabeneck MD MPH FRCPC Medical Director,
ColonCancerCheck Amanda Hey MD FCFP NE Ontario
Regional Primary Care Lead Sudbury March 19, 2009
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Why a Public Forum?

• To raise awareness of the burden of colorectal
  cancer
• To raise awareness about the Ontario Colorectal
  Screening Program
• To encourage eligible Ontarians to get screened.

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The Colon and Rectum
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What is Screening?

• Prevention or early detection
• Before symptoms or signs
• Before it becomes serious
• When it is easily treatable and at a stage when
  it is preventable

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Colorectal Cancer

• Burden of disease ?
• Evidence for screening ?
• Ontarios Screening Program ?
• North East Ontario ?

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Pamela Wallin(1953- )
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Colorectal Cancer

• 3rd most common cancer in men and women
• 2nd most common cause of cancer deaths

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New Cases in Ontario 2008
Canadian Cancer Statistics
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Deaths in Ontario 2008
Canadian Cancer Statistics
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Cancer Deaths in Ontario Women 2008
Canadian Cancer Statistics
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Life-Time Risk of Developing Colorectal Cancer

• Men 1/16 (6.3)
• Women 1/18 (5.6)

Canadian Cancer Statistics
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New Cases of Colorectal Cancer
500
400
300
Rate per 100,000
200
100
0
20-24
30-34
40-44
50-54
60-64
70-74
80-84
Age
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Red Kelly(1927 - )
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Factors Associated with CRC
FAP 1
IBD 1
HNPCC 5
Family History 15-20
Sporadic Average Risk 75
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The role of the Polyp
Normal Colon
Colonic Polyp
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Colorectal Cancer

• Burden of disease ?
• Evidence for screening ?
• Ontarios Screening Program ?
• North East Ontario ?

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CRC Screening

• Past decade Evidence to support colorectal
  cancer screening
• Fecal Occult Blood Test ? ? ?
• Colonoscopy ?

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Fecal Occult Blood Test (FOBT)
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Fecal Occult Blood Test

• In large well-designed studies,
• fecal occult blood testing (FOBT)
• reduces CRC deaths by 15-33

Mandel JS et al. NEJM 19933281365-71. Hardcastle
JD et al. Lancet 19963481472-77. Kronberg O et
al. Lancet 19963481467-71.
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Colonoscopy
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Colonoscopy

• National polyp study Colonoscopy with polyp
  removal reduces CRC incidence by 76-90

Winawer SJ et al. NEJM 19933291977-81.
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How Many of Us Are Getting Screened?
Less than 20
Rabeneck L et al. Am J Gastroenterol
2004991141-44.
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Our Challenge in Ontario

• 3.1 million 50-74 years
• lt20 screened
• Colonoscopy access
• Colonoscopy quality

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Funding for Increased Access to Colonoscopy

• Population-based
• LHIN-based
• Public hospitals

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C B C . C A   N e w s   -   F u l l   S t o r y
193 M over 5 yrs for CRC screening program

Minister of Health, George Smitherman
January 23, 2007
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Province-wide Screening Programs Announced

• 1. Ontario
• 2. Manitoba
• 3. Alberta

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Colorectal Cancer

• Burden of disease ?
• Evidence for screening ?
• Ontarios Screening Program ?
• North East Ontario ?

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What is an Organized Screening Program?

• Promotes screening
• Provides or coordinates the provision of
  screening test
• Monitors for quality and effectiveness
• Follows up the outcome of screen tests
• Reminds/ recalls for next screen test
• Evaluates the effectiveness of all components

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• Public campaign
• March 2008

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• Launch of FOBT kits-
• April 2008
• Family Physicians
• No health care provider?
• Pharmacists, INFOline

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• Average risk
• Asymptomatic, 50-74 years
• ? FOBT every 2 yrs

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FOBT Standardized Kit
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• Increased risk
• Asymptomatic, 1st degree relative (FDR) with CRC
• ? Colonoscopy at age 50, or 10 yrs earlier than
  FDR age at diagnosis

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• INFOline
• 1-866-410-5803

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Colorectal Cancer

• Burden of disease ?
• Evidence for screening ?
• Ontarios Screening Program ?
• North East Ontario ?

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Colorectal Cancer Rates 2004
Source CCO CSQI 2008
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Colorectal Cancer Ontario First Nations
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Giant Colon Tour

• Timmins 101 Mall March 21st- March 26th
• Sudbury New Sudbury Centre March 26th- April
  2nd
• Sault Ste. Marie SSM Armoury April 4th- April
  9th

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Colorectal Cancer

• Burden of disease ?
• Evidence for screening ?
• Ontarios Screening Program ?
• North East Ontario ?

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Colorectal Cancer Screening
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For More Information

• INFOline 1-866-410-5853
• Website www.coloncancercheck.ca
• Email
• coloncancercheck_at_cancercare.on.ca

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Questions?
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